Age group and suspected pathogens | Suggested parenteral empiric agent(s) | Comments |
1 to 6 months | ||
Bacterial (not Chlamydia trachomatis or Staphylococcus aureus) | One of the following:
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C. trachomatis | Azithromycin | |
≥6 months | ||
Uncomplicated bacterial (not Mycoplasma pneumoniae, Chlamydia pneumoniae, or S. aureus) | One of the following:
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M. pneumoniae or C. pneumoniae | One of the following:
| |
Clinical syndrome (any age) | Suggested empiric parenteral agent(s) | Comments |
Severe pneumonia | Combination therapy with one of the following:
|
|
Severe pneumonia requiring ICU admission | Combination therapy with:
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|
Complicated pneumonia (eg, effusion/empyema, necrotizing process, abscessΔ) | Combination therapy with one of the following:
|
|
CA-MRSA: community-associated methicillin-resistant S. aureus; Hib: Haemophilus influenzae type b; ICU: intensive care unit; CAP: community-acquired pneumonia; MSSA: methicillin-susceptible S. aureus; MRSA: methicillin-resistant S. aureus.
* Ceftaroline is a fifth-generation cephalosporin. It is available in the United States for the treatment of pediatric CAP due to S. pneumoniae, MSSA, and H. influenzae in children ≥2 months of age. Although ceftaroline has in vitro activity against MRSA, experience in children with documented MRSA CAP is limited.
¶ Nafcillin is added if S. aureus is likely because MSSA is more rapidly killed by nafcillin than by vancomycin.
Δ Ampicillin-sulbactam alone may be effective if lung abscess is thought to be secondary to aspiration.
◊ The threshold prevalence of clindamycin-resistant MRSA (constitutive plus inducible) for choosing vancomycin varies from center to center, usually ranging from 10 to 25%, in an effort to balance the benefit of definitive therapy for the patient with the risk of increasing vancomycin resistance in the community. Additional considerations in the decision to choose vancomycin include the prevalence of MRSA in the community, the severity of illness, and the turn-around time for susceptibilities.Do you want to add Medilib to your home screen?